Provider Demographics
NPI:1700060423
Name:GADE, SREENIVASA R II
Entity Type:Individual
Prefix:
First Name:SREENIVASA
Middle Name:R
Last Name:GADE
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 SENECA AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-2895
Mailing Address - Country:US
Mailing Address - Phone:718-366-7766
Mailing Address - Fax:718-366-7755
Practice Address - Street 1:714 SENECA AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-2895
Practice Address - Country:US
Practice Address - Phone:718-366-7766
Practice Address - Fax:718-366-7755
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044320183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3343857OtherNCPDP